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Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

Authors: Shen et al. Link to paper: https://jamanetwork.com/journals/jama/fullarticle/2763983

Journal/ Pre-Print: JAMA Network

Key Words: Convalescent Plasma, Treatment, Clinical Research

Research Highlights 

1. Reporting of a convalescent antibody treatment of five critically-ill patients with COVID19

2. Convalescent treatment among these five cases did not seem to have negative health effects

3. Study fails to show definite proof of effectiveness of convalescent antibody treatment

Summary 

This study reports the cases of five critically-ill patient positive for COVID19, who have been treated with convalescent antibody plasma. The authors describe that clinical symptoms of all five patients improved post-transfusion over a 12-day time period: (1) improved clinical parameters, (2) increased oxygen saturation, (3) decreased viral titres, (4) decreased multiorgan failure scores. However, all of the patients were simultaneously treated with several anti-viral drugs and the start of treatment after admission varied between patients groups. The most notable effect observed was the relatively quick decrease of viral titre after convalescent plasma treatment. Unfortunately, the study design did not allow a definite statement about the effectiveness of convalescent antibody treatment, acknowledge by the authors . 

Impact for SARS-CoV2/COVID19 research efforts

· Treatment of SARS-CoV2/COVID19 positive individuals

Using convalescent antibody plasma from recovered COVID19 patients presents a promising strategy to treat patients with ongoing SARS-CoV2 infections in the absence of a functional antiviral treatment or vaccine.

Study Type

· Clinical Cohort study (e.g. drug trials)

· Patient Case study

Strengths and limitations of the paper

Novelty: None

Standing in the field: Convalescent antibody treatment for SARS-CoV2 is currently being heavily debated and several controlled studies were started in Germany, the US and elsewhere. The effectiveness of this treatment remains to be evaluated. The safety of this type of treatment was recently corroborated by Duan et al. (2020, PNAS).

Appropriate statistics: No statistical test were applied

Viral model used: Patients with qPCR-positive SARS-CoV2 in intensive care

Translatability: High translational potential if it works in a well-controlled clinical

study (ongoing)

Main limitations:

· The study was not controlled and this makes interpretation of the effectiveness of the treatment unclear. Patients’ symptoms could have improved on their own or due to the other drugs they were taking. · The convalescent plasma input was not normalized to the antibody concentration found in the plasma of different recipients.

· the status of the endogenous immune response prior and post convalescent antibody treatment is unclear (e.g. evaluation of IgG plasma cells).

· Unclear if patient 1 and 2 (the only patients suffering from bacterial pneumonia) were on antibiotics throughout the treatment